Anxiety is one of the many emotions that is present in us. The function of anxiety is to alert us of imminent danger or threats by generating a feeling of uneasiness in our bodies. Our physical body will respond to this anxiety and manifest symptoms as a form of “fight or flight” response, — we either face these challenges head on and overcome them (“fight”) or we withdraw and escape from the issue (“flight”).

If we are unable to calm down and handle our anxiety, it could lead to more serious anxiety problems such as panic attacks and phobias.

What are the main types of anxiety disorder?

Normal Anxiety

It is normal for human beings to develop and experience anxiety in the face of threat. For example, almost everyone will feel anxious before examinations or a presentation to a group of audience. Such anxiety is confined to the event and will dissipate once the event is over, posing no threat to future well-being.

Chronic Anxiety

Chronic anxiety refers to anxiety that has become a long-term problem affecting us regularly and inhibiting normal functioning of our life. Examples of chronic anxiety are:

• Generalised anxiety disorder (GAD)
• Social anxiety
• Post-traumatic Stress disorder (PTSD)
• Obsessive-compulsive disorder (OCD)
• Panic attack
• Phobias

According to research conducted by Chang (2019), the lifetime prevalence of generalised anxiety disorder (GAD) in Singaporeans aged 18 years and above saw an increase from 0.9% in 2010 to 1.6% in 2016.

Signs and Symptoms of anxiety disorder:

• Increased heartbeat
• Racing thoughts
• Breathlessness, needing to take deep breaths
• Trembling, shivering
• Feeling agitated or irritable
• Difficulty in concentrating
• Difficulty in getting to sleep
• Waking up in the middle of the night with fear
• Fear of losing control or going mad
• Blanking out

Causes of anxiety

Fear

The root cause of anxiety is fear. It could be a constant fear of an impending disaster that is looming at large and waiting to engulf us. Anxiety can also result from intense fear of the past or uncertain future. Negative past experiences of failures and criticisms from other can result in our mind constantly worrying about the “what ifs”.

Feelings of anxiety do not manifest overnight. The seeds of anxiety could have been sown way back in our childhood. In Singapore, we live in a competitive society where academic excellence is prioritised above all else, resulting in the fear of failure constantly at the back of our minds. Over time, this fear adds up and culminates at an unbearable peak when we can no longer cope. All of a sudden, it explodes and implodes.

Fear of the future could also be due to insecurity that you face in your health, family relationships, and career. You may require the help of a psychotherapist or professional to help you through therapy sessions for anxiety.

Past traumas

If the scars of past traumas are not worked on, they will lie dormant but can affect you subconsciously. Trauma is essentially any distressing or disturbing experience, no matter how big or small it seems. It can be as small as the impact of hurtful comments made by your friends or parents, or severely traumatic experiences like death, accidents and abuse. While individuals in these circumstances may not always be at immediate risk of harm, these past traumas will leave long-lasting scars.

Sigmund Freud once said, “Emotions need to be decluttered on a regular basis. Or else they just keep on piling up. One after another they keep on adding. Unfortunately, they don’t just die with time.” Over time, we could have subconsciously piled up a bunch of hurts inside us that we are not aware of. Unexpressed emotions and unaddressed issues do not just disappear – often, they are buried alive and will come forth later in uglier ways.

In my experience working with many clients who suffer from chronic anxiety, the common trauma-related causes are:

• Parents’ – witnessing constant fights between parents; not coping well with parents’ divorce; parents having extra-marital affair
• Parenting issues – feeling neglected by parents; having controlling parents or parents who set too high expectations; being abused physically, emotionally and verbally by parents
• Not performing well academically
• Being bullied in school – suffering from verbal abuse, isolation, cyberbullying; being taunted with mean words by classmates
• Break up with boyfriend or girlfriend
• Broken marriage
• Sexual or physical abuse by significant others
• Failures in career or business

Even if these traumatic incidents have happened years ago, our body still keeps these scars and remembers the emotions. All these traumatic incidents have been locked in our subconscious. What is worrying is that we can be easily triggered in an unexpected place and time.

For instance, we may be relaxing and unwinding with a movie at home. A particular scene flashes across in the movie, triggering unpleasant emotions similar to those we experienced years ago during those traumatic times. Within seconds, we may be sent into a tailspin of anxiety. We may end up breaking out in cold sweat, feeling like nauseous and like we are unable to breathe. According to psychologists, these are all symptoms of post-traumatic stress disorder (PTSD). PTSD is a mental health condition that is triggered by a terrifying event – either by witnessing or experiencing it first-hand. It is a complex issue that requires the help of a PTSD therapist.

Overcoming anxiety disorder

Getting to the root causes of your anxiety

In order to treat anxiety problems or panic attacks, the first major task is to uncover your history through a series of questions: “When was the first anxiety attack?”, “How did it happen?”, “Who were the people who caused it, and were there significant people present?” A certified counsellor that has experience with counselling for anxiety problems in Singapore will be able to help get to the root cause of your anxiety.

Talking about these details during therapy sessions for anxiety will help you get over the feelings of shame, humiliation, pain and fear, slowly but surely. In many cases, these traumatic experiences occurred in one’s childhood, and it is the child inside you that holds the key to unlocking these feelings and memories.

After understanding the causes of your anxiety, it is the time to draw on a suite of therapeutic tools to treat the anxiety. The methods used will differ and depend on each individual’s condition.

You may be wondering about the role of medication in treating anxiety. According to Dr Leslie Lim (2010), medication alone cannot provide total cure. On the same note, he also argued that anxiety counselling alone is not entirely effective.

For many who struggle with anxiety, their emotions control them, and no amount of logic will be sufficient to calm the nerves. Therefore, individuals will require different techniques to address various causes of anxiety.

How anxiety affects our brain

Before we look at the different tools used in therapy for anxiety, it is important to understand how anxiety affects our brain.

The major part of the brain that sets off such body sensations during an anxiety attack is called the amygdala. A neuro-imaging research by Shin and Liberzon (2010) reported that there is heightened amygdala activation in response to anxiety. The amygdala is always on the lookout for potential harm. When activated, it will set off the fear alarm to alert the body of impending danger lurking. Its role is to protect us from harm by preparing us to fight or flight.

The amygdala reacts very quickly and can even bypass the cortex, which is the centre of logic. The human brain is hard-wired to allow the amygdala to seize control in times of danger. Because of this, it can be difficult to use reason-based thought processes to calm the mind and body when under threat. You may realise that your anxiety rarely makes sense to your cortex (or logic), and that you usually are not able to just reason it away.

A dire impact on having anxiety and panic attacks is the development of agoraphobia – a phobia of experiencing the fear that arises in situations where the individual feels trapped. At its extreme, such fears can hinder an individual’s day-to-day life.

Treatment of anxiety disorders using counselling and psychotherapy techniques

Unlike other emotional issues, anxiety has many facets to it and can be complicated to treat. It requires a varied suite of therapeutic techniques to target various components causing the anxiety. The earlier you start therapy sessions for anxiety, the quicker you can get well.

Anxiety disorder can be treated using the following techniques:

• Eye Movement Desensitization and Reprocessing (EMDR)
• Schema
• Gestalt
• Exposure
• Cognitive Behavioral Therapy (CBT)
• Visualisation
• Mindfulness

Techniques such as EMDR and Schema target specific past traumatic incidents that manifested into anxiety. These treatments can help to resolve the pain, hurts and fears found in an individual.

EMDR therapy helps an individual process all the emotions and body manifestations associated with a traumatic incident by letting them relive the experience again. Through the use of this technique, individuals will be able to recall the incident without the negative emotions associated with it (these emotions will be desensitised).

On the other hand, mindfulness is to be practised daily to condition the mind to experience calmness amid adversity. This method is proven to help the mind stay focused in the present moment rather than allowing the mind to worry about past or future events which can fuel anxiety.

The latest research on mindfulness by Hoffman (2010) has shown that consciously living in the present is a promising intervention for treating anxiety. According to a study conducted by Nolen-Hoekseman (2000), the beauty of mindfulness is like putting a brake to the mind that is constantly ruminating on unpleasant thoughts that trigger anxiety.

Heal with Emotional Wellness Counselling Singapore

Anxiety can be treated. You can be set free from the torment of anxiety related emotions with professional counselling and therapy sessions. Seek professional help and treatment early with Emotional Wellness’ exemplary anxiety therapy in Singapore. You can contact us by filling up the appointment form or WhatsApp us at +65 9832 4947 for a faster response.

Book recommendations

• Anxiety and Panic by Dr Harry Barry
• How to Heal Yourself From Anxiety When No One Else Can by Amy Scher
• Love is Letting Go of Fear by Gerald G. Jampolsky
• Rewire Your Anxious Brain by Catherine Pittman
• The Anxiety Cure by Klaus Bernhardt
• The Anxiety Toolkit by Alice Boyes

References

Chang, Sherilyn & Abdin, Edimansyah & Shafie, Saleha & Sambasivam, Rajeswari & Vaingankar, Janhavi & Ma, Stefan & Chong, Siow & Subramaniam, Mythily. (2019). Prevalence and Correlates of Generalized Anxiety Disorder in Singapore: Results from the Second Singapore Mental Health Study. Journal of Anxiety Disorders. 66. 102106. 10.1016/j.janxdis.2019.102106.

Hofmann, S., Sawyer, A., Witt, A.A., & Oh, D. (2010). The effect of mindfulness-based therapy on anxiety and depression: A meta-analytic review. Journal of consulting and clinical psychology, 78 2, 169-83.

Lim, Leslie (2012) Freedom From Fear: Overcoming Anxiety Disorders. Armour Publishing Pte Ltd

Nolen-Hoeksema, S. (2000). The role of rumination in depressive disorders and mixed anxiety/depressive symptoms. Journal of abnormal psychology, 109 3, 504-11.

Shin, L.M., & Liberzon, I. (2010). The Neurocircuitry of Fear, Stress, and Anxiety Disorders. Neuropsychopharmacology, 35, 169-191.

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